Chen Jonathan M, Davies Ryan R, Mital Seema R, Mercando Michelle L, Addonizio Linda J, Pinney Sean P, Hsu Daphne T, Lamour Jacqueline M, Quaegebeur Jan M, Mosca Ralph S
Division of Pediatric Cardiac Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Ann Thorac Surg. 2004 Oct;78(4):1352-61; discussion 1352-61. doi: 10.1016/j.athoracsur.2004.04.012.
Cardiac transplantation for patients with complex congenital heart disease poses several anatomic and physiologic challenges for the transplant surgeon. We undertook the current single center study to evaluate surgical outcomes and lessons learned through a nearly twenty year experience with cardiac transplantation for complex congenital heart disease.
A retrospective review was performed to evaluate all patients undergoing cardiac transplantation from January 1, 1984 through January 1, 2004. Donor and recipient demographic and intraoperative and postoperative variables were acquired and correlated with perioperative (30-day) and late mortality in both univariate and multivariate analyses, and with Kaplan-Meier survival estimates.
One hundred and six patients underwent transplantation for complex congenital heart disease and were followed for a median of 56 months. Thirty-seven (34.9%) patients died. Male gender and later year of transplantation were protective, and neonatal age and pulmonary artery reconstruction detrimental in multivariable modeling of overall mortality. Transplantation to a physiologic or anatomic single lung did not impact on survival. Patients in the study cohort had comparable survival estimates when compared with all those in the entire cohort without complex congenital heart disease. When comparing patients by era of transplantation, both cohorts demonstrated improved survival with later transplantation.
Outcomes with transplantation for complex congenital heart disease have improved annually over the past twenty years. Transplantation to an anatomic or physiologic single lung did not impair overall survival. Pulmonary artery reconstruction imparted an increase in mortality both short and long term, a finding which merits further investigation.
对于患有复杂先天性心脏病的患者，心脏移植给移植外科医生带来了一些解剖学和生理学上的挑战。我们开展了这项单中心研究，以评估通过近20年复杂先天性心脏病心脏移植经验所取得的手术结果及经验教训。
进行回顾性研究，以评估1984年1月1日至2004年1月1日期间所有接受心脏移植的患者。获取供体和受体的人口统计学数据以及术中和术后变量，并在单变量和多变量分析中与围手术期（30天）和晚期死亡率相关联，同时与Kaplan-Meier生存估计值相关联。
106例患者因复杂先天性心脏病接受了移植，中位随访时间为56个月。37例（34.9%）患者死亡。在总体死亡率的多变量模型中，男性和较晚的移植年份具有保护作用，而新生儿年龄和肺动脉重建则有害。移植到生理性或解剖性单肺对生存没有影响。与整个队列中所有无复杂先天性心脏病的患者相比，研究队列中的患者具有相当的生存估计值。按移植时代比较患者时，两个队列均显示随着移植时间的推移生存率有所提高。
在过去20年中，复杂先天性心脏病移植的结果逐年改善。移植到解剖性或生理性单肺并未损害总体生存。肺动脉重建在短期和长期均增加了死亡率，这一发现值得进一步研究。
